Clinical Outcome of Endoscopic Submucosal Dissection for Large Protruding Colorectal Tumor / 胃肠病学

ABSTRACT

Background: Endoscopic submucosal dissection (ESD) is the first choice for treating laterally spreading colorectal tumor. However, the effect of ESD on large protruding colorectal tumor is not ideal. Aims: To evaluate the features of large protruding colorectal tumor and the clinical outcome of ESD. Methods: The clinical data of 36 patients with protruding colorectal tumor with diameter ≥20 mm that undergone ESD from November 2016 to December 2019 at Beijing Hospital were retrospectively analyzed. The clinical, endoscopic, surgical and pathological features were summarized, and the risk factors of ESD were analyzed. Results: The average diameter of 36 lesions was (25.44±5.57) mm. All lesions were located in left hemicolon. The percentage of en bloc resection was 75.0%, and the percentage of R0 resection was 72.2%. ESD procedure was discontinued in 5 patients (13.9%) and were converted to surgery. The rate of curative resection was 55.6%. Non-curative resection was found in 11 patients, and of them 7 patients accepted surgery later. The overall rate of surgery was 33.3%. The en bloc resection rate (0 vs. 87.1%, P=0.003) and R0 resection rate (20.0% vs. 80.6%, P=0.008) were significantly decreased in muscle-retracting sign group than in non-muscle-retracting sign group. There were significant differences in en bloc resection rate, R0 resection rate and curative resection rate among the non-submucosal fibrosis (F0), mild fibrosis (F1) and severe fibrosis (F2) groups (P<0.001, P=0.000, P=0.010). Conclusions: The ESD procedure of large protruding colorectal tumors ≥20 mm is technically difficult. The rates of the en bloc resection and R0 resection are low, and the curative resection rate is even more lower. Muscle-retracting sign, severe submucosal fibrosis are the important factors that affecting the outcome of ESD operation.